0398 The Therapeutic Relationship Matters: Working Alliance Quality as a Predictor of Post-Treatment Insomnia Severity in Cognitive-Behavioral Therapy for Insomnia (CBT-I)

Abstract

Introduction: Prior research has shown that the therapeutic alliance is a contributor to change in general psychotherapy and in group psychotherapy for insomnia. Little is known about how the patient‐rated quality of the working alliance relates to insomnia severity outcomes in individual Cognitive‐Behavioral Therapy for Insomnia (CBT‐I). Methods: This study included data from 64 participants who were randomized to and completed five sessions of CBT‐I during pregnancy as part of a randomized controlled study of perinatal insomnia. Participants were pregnant women (mean age=33.9, SD=4.5) with insomnia disorder, not receiving other treatments for insomnia. Measures included the Insomnia Severity Index (ISI), completed at pre‐ (mean=15.5, SD=4.3) and post‐treatment (within two weeks after Session 5, mean=7.6, SD=5.0). Participants completed the Working Alliance Inventory‐Short Revised (WAI‐SR) form following Session 2, and the total score was calculated to measure working alliance quality (mean=75.6, SD=9.2). Results: A two‐stage hierarchical multiple regression analysis demonstrated that, after adjusting for pre‐treatment insomnia severity scores, the quality of the working alliance was a significant predictor of insomnia severity scores at post‐treatment (F(2,61)=5.79, p